Life changed for Nghia Dong and his family the day he learned the pain he was suffering was caused by stomach cancer. Since that day there has not been a single day like any of the old days. We go through life hardly noting the passage of time, now each day brings with it a new meaning, a new outlook, a new dilemma, which, in the barrage of unanticipated concerns, often goes unrecognized or unappreciated. As cancer cells consume the body, everyone’s thoughts become consumed with fear. This is not surprising; cancer is a disease that is still spoken of with subdued voices, its initial pronouncement echoing sounds of the death knell. Cancer is a disease that also plays with the emotions of patients and their loved ones. Yet, there are survivors and somewhere in the wide emotional swings lies reason for hope. In Nghia’s case, however, valuable time was lost due to an initial misdiagnosis.
From the very beginning there has been openness among Dong family members about Nghia’s prospects for survival. For some, during the early days, the comforting protection offered by denial provided a measure of solace. But by holding frank discussions and consultations with doctors (pre- and post-surgery, pre- and post-treatments, this is a time when you cannot ask too many questions), and during family meetings, everyone is apprised of Nghia’s condition, and of the process and prospects through each stage. This knowledge has not made it any easier for some members of the extended family. While preparations are being made for the inevitability of Nghia’s passing, no one is ready to give up hope.
Nghia Dong was a soldier during the Vietnam War. He spent most of the war in the service of the American Consulate where he personally placed himself at risk, being wounded in the process, in the defense of those he was assigned to protect. His mind still functions like a soldier as he finds himself once again in battle, only this time he has been ambushed and weakened by a silent and unseen enemy. This is a personal battle, one that he would like to fight on his own terms, confronting the enemy directly; however, he cannot fight this battle alone. The battle against cancer requires unconventional weapons; first, as much of the enemy as possible must be surgically removed, then, after recovery, a strict regimen of radiation and chemotherapy. At the same time the patient’s body is being assaulted, inside and out, by friend and foe, the patient needs to draw on all resources available to maintain the strength needed to continue the battle. The bravery Nghia exhibited during his service in still sustains him, he will need all of it if he is to survive the next, more robust round of treatments. He was successful in his personal duties to the American Consulate, yet, the larger war was lost, in the same respect, he will not be able to defeat cancer, but on a personal level he may overcome the enemy trying to destroy him from within.
As a young man fleeing , Nghia met his future wife in a moment of tenderness. Hanh was a seasick young woman traveling on the same boat when she vomited on his shoes. Nghia, overcome with compassion and attracted by her beauty, which is evident in early photographs of her, attempted to comfort her by putting his arms around her shoulders and holding her tightly against his body. When they reached their destination they separated, but each had come to know the other well enough, that when a chance meeting brought them together again, they recognized each other. If not initially smitten with this captivating young woman, he was now and endeavored to make the most of this opportunity. It was during this second meeting that they decided to stay together and raise a family. After the birth of two children, the young couple was forcefully separated, this time by Hanh’s brother who did not approve of their relationship. The children were sent to live with other families and Hanh was placed in the care of an uncle who found employment for her away from where she had been living with Nghia. Through an extraordinary test of wills, Hanh and Nghia were able to reunite. However, they were unsuccessful in their attempts to reclaim their two children who still live in . They made a fresh start with a daughter, Thuy, and after evacuating during the fall of , they went on to raise a family of five children.
There are two glaring aspects of cancer that weigh heavily on all involved: the emotional highs and lows and the visibility of the disease. Each seems equally difficult to cope with for a patient and family. Even a staunchly positive outlook surrenders to doubt at times, proving the fickleness of the mind to be as insidious as the disease itself. The rogue cells wreaking internal havoc and consuming stomach tissue are not visually evident. When we look at the patient, it is the physiognomy of stomach cancer that we actually see. We see the face of cancer by watching someone succumb to the disease, by observing the body wasting away, by the pained expressions that reach out to us who are essentially powerless beyond sympathy. It is in the decline of the patient that we witness these malignant cells growing, multiplying, and spreading.
The responsibility for arranging Nghia’s medical treatment has been shouldered by his daughter, Thuy, though always in consultation with him, moving forward only with his consent. She has a special bond with her dad, which almost makes agreement a one-sided affair. Her love and respect for him are boundless, so more often than not, though it sometimes takes a little badgering, she manages to convince him to follow a particular regimen designed to prepare him for the next step in the process. The end goal of this process is life. Most of the financial responsibilities have been delegated to Hiep, the eldest son living in the . This balance suits everyone and is in keeping with traditional Vietnamese culture.
Hanh, Nghia’s wife of 50 years, and Thuy have assumed the role of primary caregiver. This often leads to contentious confrontations between mother and daughter over what is best or what mistakes are being made. The family prides itself on being communicative, with clear, precise instructions being necessary to sustain proper medical care. At times, there has been confusion over medications and dietary needs. In fact, food consumption has been a particularly tricky issue; first, there was the need to reestablish the desire to eat, then, once the appetite returned, with the aid of medication, the process of eating had to be controlled to prevent overeating, which often led to vomiting, also controlled by medication. To combat this, a schedule calling for as many as eight small meals over the course of a day was instituted. However, as simple as this seems, this schedule takes vigilance and determination to maintain, and it has proved extremely difficult for both caregiver and patient to follow.
Exercise is another critical element on the path to wellness; it is beneficial for both mind and body. Here, too, the desire to want to make things easier for the patient is counterproductive. As long as Nghia is able to do certain tasks, family members should refrain from attempting to help him every chance they get. While this goes against one’s
natural inclinations, it is for the benefit of the patient. To some extent, so as not to appear helpless, he will make the effort on his own. When walking, Thuy often asks her dad to rate his pain on a scale from 1 to 10. Repeated high numbers resulted in a visit to the doctor’s office and the discovery of a blood clot in his left leg, and the need for more medication. These days, Nghia gets around with the aid of a cane. Initially, he was upset at the thought of using a crutch of any type to help with walking; now it seems to lend a semblance of authority to his stride, as well as an occasional extension to his arm. When necessary, a wheelchair is pressed into service to the welcomed relief of tired, painful legs.
For Hanh and Nghia this is an especially difficult time. She worries about being left alone and he worries about leaving her alone. They sometimes bicker about this, Nghia telling his wife that she better find another man because he will not be here for her much longer, which, of course, only upsets her. In the early stages of Nghia’s treatment, Hanh insisted that she would die before her husband. She was certain that he would survive just as he had survived his wounds during the Vietnam War; now realizing that this is no longer likely, her mind struggles to deal with the implications and at times she is reduced to quiet tears. To watch her coddle him at home is to be reminded of how deep and strong their love for each other remains. While her movements around him have certainly changed since the onset of cancer and in response to his own changing needs, they come across as the same unconscious expressions of affection that exist between two people who have been together for many years.
Cancer changes how family and friends interact with the cancer patient. This is as much a side effect of cancer as the visible degradation of the body. Often there is confusion or befuddlement that expresses itself as pity, which has a demoralizing effect, likely to upset the patient. It can be difficult, even for adults, to speak freely with someone they know to be dying. How does one pick up the thread of an ongoing conversation and then leave it dangling, expecting to pick it up again on the next visit? How does one say good-bye at the close of each visit, thinking they may not get the chance between now and next time? Visitors and family alike should ask questions about the process, the treatment, the doctors, or tell stories about the past, talk of current events, news, or how common friends are getting along, and determine from the response which questions the patient is more comfortable answering and follow that line of conversation. Above all, it is important to respect the dignity of the patient.
For Shawn and Julie, the two grandchildren living at home, who probably have always thought of their grandfather as a household fixture, overt expressions typically take the form of physical gestures. Shawn will help his grandfather, or spend time with him when no one else is available, but there is very little substantive communication. In fact, his grandfather’s illness seems to have had little impact on his life. At 18, he is at that age when spending time with friends, in particular, a girlfriend, is more important than enjoying some of the precious time his grandfather has left. No doubt he will feel a certain amount of sadness, but he is also matter-of-fact about the possibility of his grandfather dying soon.
Julie hugs her grandfather in a way that appears genuinely natural and unpremeditated, which must be comforting for both, but she too finds it impossible to talk to him. There are obvious questions that all children should be asking their elders. If a child is not precocious enough to participate in this kind of open dialog, one that grows more intimate over time, it will only become harder as the child gets older to express affection. Despite growing up in her grandfather’s house, Julie cannot find that level of comfort to speak freely to him about her feelings. She can articulate these feelings in a general way to others when asked, but like Shawn, she finds it easier to avoid the issue rather than confront it.
There are times when Nghia appears to fall asleep and discussions spring up around him with the airing of emotions too sensitive to express to him directly. The frustration of being unable to say, for uncertain reasons, the genuine feelings in the heart, forces open a valve. Whether he hears any of this venting is unknown, but if so, how is it being processed? It is quite likely that he understands their frustrations and accepts the expressions of affection that he receives from them, knowing a greater, unspoken meaning lies behind them.
Phuong, a daughter living at home and mother of Shawn and Julie, has been dependent, for many years, on the generosity and support of her parents. She loves her father, but is dealing with this family crisis by distancing herself from the center of activity. For her, it is comforting to cry a little every day. Unlike Julie, Phuong shuns physical contact, and like both her children, she never openly expresses her feelings, preferring to keep the hurt inside. While she says silly things to give the impression of being insensible or dimwitted, she may be the most perceptive observer of her father’s own reaction to his cancer. Despite being marginally cognizant of the discourse, she listens and observes, and may be processing more than the active participants who are focused on particular issues and immediate concerns. She believes her father knows that he cannot beat death this time and that he would prefer to manage the remainder of his life in a way that would minimize the trauma of his death on his family. She understands that he cannot give up without a fight, that he will not abandon his family without a struggle. For this reason he moves forward, pushing onward like a soldier. Ultimately, it is the impending changes that worry her more than anything else. She is aware that her father’s death will likely have a greater impact on her life than on any of the other family members.
Hiep the second son here in the U.S. is married with his wife Linda and daughter Maddie. He represents the good son who holds a good job, raise a good family and is up there living the American dream. He is busy so guilt does set in sometime. He is trying his best when he has time off to help dad cut the lawn and help take mom to the big Costco store. There were many time he fight with his wife for time with his dad family and it make it hard for the family to have dealing with the in-laws.
Nam is the baby of the family and he is represent as the other son who has stray and has disappoint the family many time. He gets in to trouble a lot with the law and with financial. Among the family Thuy his sister has put her townhouse up for bond to bail him out before and has loss a Honda vehicle which she helps paid for and then the police confiscated because of drug. Still till the end on Mother’s day he fights with his parent and did not drive them down to celebrate Hiep birthday and Mother’s day in Leesburg.
He is an angry young man-- maybe because of a loss in 1990 of his brother Si who die in a drowning accident at . He has never been the same since. In life there are separations that should prepare us for the parting of loved ones through death. Painful as these separations often are at the time, life continues, sometimes better and sometimes worse than what came before. Nam still plays in a band and seems to cares more about his friends than to spend time with his dying father.
. The idea of death represents a release for both patient and loved ones. It represents the end of obligation, of certain tasks that caregivers have difficulty performing, finding it futile to prevent the body from surrendering completely to the disease consuming it. More importantly, it brings to a close the patient’s suffering. The decision to skip or suspend treatments rests with the patient and should be based on an honest prognosis. Once this decision is reached, it should be respected.
In death there is no going back; every opportunity one thought one would always have to ask or answer is now lost. There will no longer be occasions for hugs, handshakes, or kisses, no more smiles, laughter, or other expressions of endearment. Death robs us of our time with family and friends. Cancer frequently puts patient and family on the fast track, stealing time from them by forcing them to confront the disease, and when it is too late for anything more, leaving them to witness the painful end.
The loss of a loved one leaves painful emotions that linger long after the patient has departed. There will always be reminders, whether physical objects or memories, which keep the deceased in our thoughts. Remaining in the family home can be as painful as it is comforting. It may take a strong constitution to be surrounded by the tangible evidence of the departed, with daily reminders of their absence everywhere. Touching familiar objects is a way of connecting, a way of not letting go. To live everyday in a reverie of the past is to rob the sufferer of the future and of any hope for healing. Nghia may have had this in mind when he decided to sell the house that the Dong family has called home for the past 17 years. Lost will be the comfort of familiar surroundings, the gardens where Hanh grew Vietnamese vegetables that she sold to the local Vietnamese community, a thriving business that helped supplement her husband’s income, and the network of friends who will now have to travel greater distances to visit the family. This secondary loss will force additional radical changes on some members of the family.
Each member of Nghia Dong’s family is confronting his cancer differently; each realizing that this crisis will dramatically change their lives in ways they had not anticipated. Whether out of complacency or simply by being involved with life, no one was prepared for this. In fact, people rarely are. To lose the hub of a wheel leaves the spokes unsecured and at risk of falling out. The wheel, losing its structural support, will collapse. The Dong family may be too busy at this stage of Nghia’s treatment to be thinking about what will happen after he is gone. Even though the spokes fall out, they will manage to hold the family together as a way of honoring Nghia Dong’s memory.
by Woody Woodis
